U. S. Children 4-17 Years of Age Who Received Services for Emotional or Behavioral Difficulties: Preliminary Data From the 2005 National Health Interview Survey
by Gloria A. Simpson, M. A., Robin A. Cohen, Ph.D., Division of Health Interview Statistics; Patricia N. Pastor, Ph.D., and Cynthia A. Reuben, M.A., Office of Analysis and Epidemiology
Children’s emotional or behavioral difficulties affect many aspects of their lives--achievement in school, relationships with family and friends, and the risk of alcohol or substance abuse (1-3). Early intervention and treatment may prevent a child’s emotional or behavioral difficulties from worsening and lessen some of the negative outcomes associated with mental health problems (3). However, finding appropriate, affordable, and family-oriented treatment for children with emotional or behavioral difficulties, as recommended in the New Freedom Commission on Mental Health’s Report, is often a challenge (3).
To monitor children’s use of mental health services and treatment, the Substance Abuse and Mental Health Services Administration (SAMHSA), the National Institute of Mental Health (NIMH), and National Center for Health Statistics (NCHS) collaborated to develop new questions about children’s use of mental health services for the 2005 National Health Interview Survey (NHIS) Sample Child Questionnaire. The questions may be viewed on the NHIS Web site. This Health E-Stat highlights preliminary national estimates based on responses to these questions.
NHIS, a survey of the noninstitutionalized civilian population of the United States, has been an important source of information about health and health care in the United States since it was first conducted in 1957. NHIS is a multistage probability sample survey that is conducted continuously throughout the year by interviewers of the U. S. Census Bureau for the Centers for Disease Control and Prevention’s NCHS. For further information about NHIS, see the NCHS Web site.
In the 2005 NHIS Sample Child Questionnaire, the adult who knew the most about the child’s health (usually a parent) was asked questions about the child’s health and use of health services, including new questions about services for emotional or behavioral difficulties. In this E-Stat, services or help includes:
- A child’s parent seeing or talking to a health care provider or school staff about the child’s emotional or behavioral difficulties,
- A child being prescribed medication for emotional or behavioral difficulties,
- A child being prescribed medication for a particular set of emotional or behavioral difficulties, specifically for difficulties with concentration, hyperactivity, or impulsivity, and
- A child receiving treatment or help other than medication for emotional or behavioral difficulties.
Providers of mental health treatment or help other than medication include mental health private practice, clinic, or center, child’s school, a pediatric or general medical practice, or other places. This analysis includes responses collected during January-June 2005 on a total of 4,668 children 4-17 years of age in the Sample Child Component of the survey. Because NHIS is conducted throughout the year and the sample is designed to yield a nationally representative sample each week, data can be analyzed weekly or quarterly. NCHS creates weights for each calendar quarter of the NHIS sample. NHIS data weighting procedures have been described in more detail at Series Report Number 2, Volume 130 [PDF - 299 KB]. Because the estimates using the January-June 2005 data are being released prior to final data editing and final weighting, they should be considered preliminary and may differ slightly from estimates using the final data files.
Point estimates and estimates of corresponding variances were calculated using the SUDAAN software package (4) to account for the complex sample design of the NHIS. The Taylor series linearization method was chosen for variance estimation. All estimates shown meet the NCHS standard of having less than or equal to 30% relative standard error. Differences between percentages or rates were evaluated using two-sided significance tests at the 0.05 level. Terms such as "higher than" and "less than" indicate a statistically significant difference. Terms such as "similar" and "no difference" indicate that the statistics being compared were not significantly different. Lack of comment regarding the difference between any two statistics does not necessarily suggest that the difference was tested and found to be not significant.
In 2005, 16% of U. S children 4 to 17 years of age had parents who had talked to a health care provider or school personnel about their child’s emotional or behavioral difficulties during the past 12 months (Table 1 [PDF - 21 KB]). Talking to a health care provider or school personnel about a child’s difficulty does not necessarily indicate that the child received treatment. Nearly 5% of U.S. children 4-17 years of age were prescribed medication for emotional or behavioral difficulties during the past 12 months. Of the children prescribed medication, 88% were prescribed medication for difficulties with concentration, hyperactivity or impulsivity, the major symptoms of ADHD.5 About 6% of all U.S. children received some type of mental health treatment or help other than medication during the past 12 months.
The percentage of children receiving services for emotional or behavioral difficulties differed significantly by sex. Twenty percent of the boys, compared with12% of the girls, had parents who had talked to a health care provider or school staff member about the child’s emotional or behavioral difficulties during the past 12 months. Approximately 7% of boys were prescribed medication compared with 3% of girls. Finally, a larger percentage of boys (7%) than girls (4%) received some type of treatment or help other than medication.
The percentage of children whose parents talked to a health care provider or school staff about the child’s emotional or behavioral difficulties during the past 12 months did not differ between younger children (4-11 years of age) and older children (12-17 years of age). However, a higher percentage of older children compared with younger children were prescribed medication for emotional or behavioral difficulties and for difficulties with concentration, hyperactivity, or impulsivity. Also, a higher percentage of older children compared with younger children received some type of mental health treatment other than medication.
Children who received treatment or help other than medication for emotional or behavioral difficulties (approximately 6% of all children 4-17 years of age) received services from a variety of providers. Figure 1 shows the percentage of children 4-17 years of age who received nonmedication treatment by provider type. About two-thirds received treatment or help at a mental health private practice, clinic, or center; slightly less than half at the child’s school; and a quarter at a pediatric or general medical practice. Approximately 30% of children receiving nonmedication treatment received services from more than one type of provider.
The findings of this report are based on preliminary data. Future reports will examine the final data from the new questions in more detail.
- Simpson GA, Bloom B, Cohen RA, Blumberg S, Bourdon KH. U.S. Children with emotional and behavioral difficulties: Data from the 2001, 2002, and 2003 National Health Interview Surveys. Advance data from vital and health statistics; no 360. Hyattsville, MD: National Center for Health Statistics. 2005.
- Glied S, Cuellar AE. Trends and issues in child and adolescent mental health. Health Aff (Millwood). 22(5):39-50. 2003.
- New Freedom Commission on Mental Health. Achieving the Promise: Transforming Mental Health Care in America. Final Report.
- Research Triangle Institute. SUDAAN (Release 9.1) [Computer Software]. Research Triangle Park, NC: Research Triangle Institute. 2004.
- American Psychiatric Association. Attention-Deficit Disorder and Disruptive Behavior Disorders. Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition (DSM-IV-TR): 85-93. Washington. 2000.
Simpson GA, Cohen RA, Pastor PN, Reuben CA. U. S. children 4-17 years of age who received treatment for emotional or behavioral difficulties: Preliminary data from the 2005 National Health Interview Survey. Health E-Stats. National Center for Health Statistics. Released February 16, 2006.
- Page last reviewed: November 6, 2015
- Page last updated: March 31, 2010
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